Individual
AMY MOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
601 7TH ST S STE 510, ST PETERSBURG, FL 33701-4736
(727) 828-6330
Mailing address
PO BOX 1289, TAMPA, FL 33601-1289
(813) 844-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101907
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291237600
—
FL
Enumeration date
08/13/2006
Last updated
06/05/2019
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